| NPI | 1215598685 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA253004) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 137874) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2025-01-30 |